Professional Documents
Culture Documents
DOI 10.1007/s00431-011-1592-5
REVIEW
Introduction
Resistance to antibiotics is a global problem that is
especially pronounced in developing countries. Bacterial
resistance significantly prolongs the time of treatment and
contributes to the occurrence of side effects which elevates
the cost of treatment [8, 12, 42]. In addition, once the genes
that determine bacterial resistance to antibiotics are acquired,
these genes cannot be easily lost since they become a
relatively stable part of the bacterial genome. Bacteria, after
contact with a number of antibiotics, become multiresistant,
which then reduces the number of treatment options [48].
Infections caused by resistant bacterial strains were
previously acquired mainly in hospital settings. However,
nowadays, they are increasingly present in the extrahospital environment [35]. Children, especially infants, are
particularly sensitive to these infections which contribute to
high mortality in countries with inadequate health care. For
example, in Asia, one infant dies every 2 min due to
infections caused by resistant bacteria [15].
The most common bacterial infections in children are the
acute infections of the respiratory, gastrointestinal and
Eur J Pediatr
Methods
Computerized search through the Medline of published
articles on antibiotic resistance from 1996 to 2011 in English
or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/
antibiotic and resistance/susceptibility in pediatric/children,
and Streptococcus pneumoniae/Streptococci/Haemophilus
influenzae/Salmonellae/Escherichia coli/Shigella/
Staphylococcus aureus and antibiotics/antimicrobials/
antibacterials consumption/utilization/use. Reviews, editorials
and case reports were excluded. Collected pieces of information included author, year of study and publication,
country where the study was conducted, age and size of
the studied population, level of antibiotic resistance and
antibiotic utilization (in defined daily doses (DDD) per
1,000 inhabitants per day).
Eur J Pediatr
Table 1 Antibiotic resistance shown by Streptococcus pneumoniae in children from 1984 to 2006
Country
Erythromycin
Tetracycline
Co-trimoxazole
Sweden
1997
4.7
The Netherlands
1998
France
1984
13
1990
48
19951996
5768
1997, 1998
46.253
47
1993
5.5
1998
2002
3.5
12.2
1989
2004
42
47
Italy
19961997
4260
Spain
19921996
2336
1998
72
Portugal
20002001
Turkey
19931996
Germany
Switzerland
SaudiArabia
Singapore
43.9
20.7
3.539.9
9.8
28
1999
14
33
2004
3.4
42
34.6
44
1988
1995
17
30
19971999
67.8
87.7
n.d.
80
72
32
0
23
Vietnam
1999
88
China
80
20002002
6.4
7090
7090
7090
20002005 (Beijing)
25.9
90
94
87b
20052006
64.389.6
1997
399a
70
2003
399a
97
19992004
25.550
93
82.2
79.4
19982000
71
20022003
75.2
70
87.6
14.9
Taiwan
Japan
South Korea
19992000
Australia
19971999 (Canberra)
USA
1995
67
19981999 (South)
32.5
38.6
19981999 (South-East)
36.4
40.2
19981999 (North-West)
17.3
23.3
19992000 (Texas)
38.2
49.1
27.3
50.9
19992000 (Washington)
35
45
20
40
19992000 (Wisconsin)
32.1
34
16.7
41.5
2000 (Jacksonville)
52
64
n.d. no data
a
This study also assessed the antibiotic utilization. There was a high correlation between antibiotic use and occurrence of resistant strains of
Streptococcus pneumoniae. The rationalization of antibiotic utilization decreased antibiotic resistance levels
longer, more complex and more expensive [12, 34, 36, 43, 74].
Thus, during the 14-month study period in Greece (from 1997
to 1998) in children under 2 years of age, the existence of
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Table 2 Factors contributing to the development of antibiotic resistance and strategies to control its advancement
Factors contributing to AB resistance
Prophylactic administration of AB
Antibiotic
Eur J Pediatr
Conclusion
The most important socio-economic factors leading to the
development of antibiotic resistance are irrational and
uncontrolled use of antibiotics in medicine, veterinary
medicine and agriculture; poor sanitary conditions in certain
parts of the world and global migration of people and goods.
Antibiotic resistance needs to be addressed by each country,
depending on its specific issues and requirements. It is
mandatory to have clearly defined regulations on prescribing,
dispensing and using antibiotics in human and veterinary
medicine as well as in agriculture. In addition, it is necessary to
have a control over the implementation of regulations and to
sanction the violations. Education of physicians, pharmacists
and the general community is also an important component.
Patients need to understand that their adherence to therapeutic
regimen is of crucial importance not only to the effectiveness of
therapy but also to reducing bacterial resistance. Developed
countries already managed to reduce problem of antibiotic
resistance with antibiotic surveillance and by implementation
of a strict control over antibiotic utilization. However, as
antibiotic resistance is a global problem, in order to be solved, it
requires a joint effort of the whole international community.
Acknowledgements Katarina Ilis and Vesna kodri-Trifunovis
work is supported by the Ministry of Education and Science, Republic
of Serbia, Project No. 175064 and 175046, respectively, 2011-2014.
Conflicts of interest None.
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